非球面人工晶状体植入眼的视觉质量分析

目的 观察非球面人工晶状体(IOL)、球面IOL植入眼与正常中青年人眼的波前像差和对比敏感度差异.方法 46例(49只眼)老年性白内障患者随机分成两组,分别植入非球面IOL Acrysof IQ(SN60WF)和球面IOL Acrysof Nature(SN60AT).随机选择同期正常中青年人(年龄20~40岁)作为对照组.分别对术后3月的患者和对照组进行最佳矫正视力、像差和对比敏感度检查.结果 IQ组的球差显著小于Natural组(P ＜0.05),而和正常中青年组比较无统计学意义(P ＞0.05);两IOL组的高阶像差和慧差均显著大于正常中青年组(P ＜0.05).非眩光状态下,IQ组在低频时(6.3degrees)的对比敏感度显著高于Natural组(P ＜0.05),和正常中青年组比较无统计学意义(P ＞0.05);眩光状态下,IQ组在低频时(6.3和4.0degrees)的对比敏感度显著高于Natural组(P ＜0.05),两IOL组在所有视角下的对比敏感度均显著低于正常中青年组(P ＜0.05).结论 非球面IOL植入能使白内障患者术后眼内球差明显减小,非眩光状态下低频时的对比敏感度明显提高,更接近正常中青年人眼水平,具有比球面IOL更佳的视觉质量.     

基于模型眼复曲面IOL纵向色差的评价

目的评价复色光环境下球面、非球面、toric IOL的纵向色差。方法实验研究。在Zemax光学设计软件中建立Hwey-Lan Liou模型眼,使用光线追迹法计算SN60AT IOL、YA60BB IOL、Tecnis ZA9003 IOL和3种型号toric IOL的纵向色差。使用Originpro 7.5（美国OriginLab公司）制图软件绘图。结果复色强光环境下SN60AT IOL的纵向色差是2.35 D,YA60BB IOL是2.06 D,Tecnis ZA9003 IOL是1.57 D。3种型号toric IOL的纵向色差是2.34 D,材料色散系数小的IOL有较小的纵向色差;球面SN60AT和T3、T4、T5 toric IOL有相同的纵向色差;暗光环境的纵向色差大于强光环境。结论Abbe数越大,IOL的纵向色差越小。低散光度的toric IOL与球面IOL有相同的纵向色差。     

白内障超声乳化术后混浊人工晶状体置换术

目的探讨白内障超声乳化术后人工晶状体(intraocular lens,IOL)混浊的原因与治疗方法 ,研究改良手术方式以减少手术并发症。方法收集2001年8月至2011年1月在我院因超声乳化白内障吸出联合Hydroview H60M IOL植入术后远期IOL发生混浊的患者14例,在表面麻醉下行IOL置换术,比较术前与术后最佳矫正视力。术中采用IOL剪碎法、旋转法等方式将IOL取出,重新植入STAAR公司疏水性KN-X IOL。将取出的IOL在显微镜下进行观察拍照,用钙特异性茜素红染色并进行病理检查,与未使用的Hydroview H60M IOL对比观察。结果所有病例均成功实施IOL置换术,术后视力为0.4~1.0,有10例IOL重新植入囊袋内,有4例置换的IOL植入睫状沟内。术中晶状体后囊膜破裂1例、晶状体襻残留1例、睫状体出血2例、黄斑囊样水肿2例。混浊IOL茜素红染色呈阳性反应,光学部表面有粗糙的着色颗粒,光学部内有细小颗粒所组成的云雾状或团状着色区。结论 IOL混浊与IOL材质、IOL表面钙离子富集有关,IOL置换术是改善IOL混浊患者视力的有效方法 ,术中使用改良技术可以减少手术期并发症的发生。     

Self-repositioned intraocular lens in a vitrectomized eye

A 40-year-old man had phacoemulsification through microincisions with placement of a foldable single-piece acrylic intraocular lens (IOL) (Acri.Smart 48S, Acri.Tech) in a previously vitrectomized eye, and the IOL sank into the vitreous space through a capsule tear. The patient remained aphakic postoperatively, with the IOL moving around due to gravity. He had frequent follow-up visits for close observation. During evaluation 4 months after surgery, the vision was better and examination revealed that the IOL had returned to the front of the capsule.     

超声乳化白内障吸除术后和囊外白内障摘除术后患者生存质量的比较

目的　比较超声乳化白内障吸除人工晶状体植入术后和囊外白内障摘除人工晶状体植入术后患者生存质量的变化。方法　分别于术前和术后 1周、1个月、3个月 ,观察 116例单眼超声乳化白内障吸除人工晶状体植入术后患者 (Ⅰ组 )和 93例单眼囊外白内障摘除人工晶状体植入术后患者 (Ⅱ组 )的眼部情况 ,使用生存质量调查量表记录分数。结果　术前生存质量总分数和各指标分数、术后 1个月和 3个月的自理和活动指标分数 ,Ⅰ组与Ⅱ组比较差异均无显著意义 (P >0 0 5 )。术后1周生存质量总分数和各指标分数、术后 1个月和 3个月的社交和心理指标分数 ,Ⅰ组高于Ⅱ组 ,两组比较差异均有显著意义 (P <0 0 5 )。结论　超声乳化白内障吸除人工晶状体植入术后患者的生存质量得到明显提高 ,手术效果好于囊外白内障摘除术。但是 ,本研究的观察时间较短 ,远期结果尚待深入探讨。     

Optical quality of toric intraocular lens implantation in cataract surgery

AIM: To analyze the optical quality after implantation of toric intraocular lens with optical quality analysis system. METHODS: Fifty-two eyes of forty-four patients with regular corneal astigmatism of at least 1.00 D underwent implantation of AcrySof toric intraocular lens, including T3 group 19 eyes, T4 group 18 eyes, T5 group 10 eyes, T6 group 5 eyes. Main outcomes evaluated at 3mo of follow-up, included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual refractive cylinder and intraocular lens (IOL) axis rotation. Objective optical quality were measured using optical quality analysis system (OQAS Ⅱ?, Visiometrics, Spain), included the cutoff frequency of modulation transfer function (MTFcutoff), objective scattering index (OSI), Strehl ratio, optical quality analysis system value (OV) 100%, OV 20% and OV 9% [the optical quality analysis system (OQAS) values at contrasts of 100%, 20%, and 9%]. RESULTS: At 3mo postoperative, the mean UDVA and CDVA was 0.18±0.11 and 0.07±0.08 logMAR; the mean residual refractive cylinder was 0.50±0.29 D; the mean toric IOL axis rotation was 3.62±1.76 degrees, the mean MTFcutoff, OSI, Strehl ratio, OV 100%, OV 20% and OV 9% were 22.862±5.584, 1.80±0.84, 0.155±0.038, 0.76±0.18, 0.77±0.19 and 0.78±0.21. The values of UDVA, CDVA, IOL axis rotation, MTFcutoff, OSI, Strehl ratio, OV100%, OV20% and OV9% depending on the power of the cylinder of the implantation were not significantly different (P>0.05), except the residual refractive cylinder (P<0.05). CONCLUSION: The optical quality analysis system was useful for characterizing the optical quality of AcrySof toric IOL implantation. Implantation of an AcrySof toric IOL is an effective and safe method to correct corneal astigmatism during cataract surgery.     

Hwey-Lan Liou模型眼中Toric人工晶状体旋转对成像质量的影响

背景 目前关于Toric人工晶状体(IOL)旋转造成散光残留的研究较多,但其对成像质量和波前像差带来的影响尚不清楚. 目的 评价Toric IOL旋转对成像质量、波前像差及球镜和柱镜度残留的影响. 方法 将+22.0 D T3、T4、T5型Toric IOL分别植入Hwey-Lan Liou精密模型眼,IOL后表面平坦轴置于X轴,陡峭轴置于Y轴,在波长为550 nm的单色光和瞳孔直径4 mm条件下采用Zemax光学设计软件模拟带有Toric IOL的角膜散光模型眼.将Toric IOL分别旋转5°和10°,分别测定Toric IOL在居中位及旋转位的调制传递函数(MTF)及离焦、散光、彗差、三叶草像差和球差,计算该条件下模型眼出现的球镜和柱镜的屈光误差. 结果 Toric IOL居中时角膜散光可完全矫正,T3、T4、T5型Toric IOL的MTF非常接近,随着Toric IOL旋转度变大,40 ～ 60 c/d高空间频率下成像质量明显下降,3种晶状体MTF曲线均逐渐下降,以散光度大的T5型Toric IOL下降最为明显.Toric IOL旋转后彗差、三叶草像差和球差无明显变化,但散光度和离焦均增加.Toric IOL旋转后残留散光度增加,同时球镜度增大.结论 Toric IOL植入后位置的旋转导致眼的成像质量下降,散光度较大的Toric IOL旋转引起的MTF曲线降低更为明显.Toric IOL的旋转主要造成散光和球镜度的增加,但高阶像差不受影响.     

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye

AIM:To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens(IOL)in patients with contralateral monofocal IOL.METHODS:Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled.After 1,6,and 12 mo,uncorrected and distant corrected distant visual acuity(UCDVA and DCDVA),uncorrected and distant corrected intermediate-visual acuity(UCIVA and DCIVA),uncorrected and distant corrected near visual acuity(UCNVA and DCNVA),and contrast sensitivity were obtained.Halo/glare symptoms,spectacle dependence,and patient satisfaction were also evaluated.RESULTS:The mean age was 67.86±7.25 y and the average interval between two IOL implantations was 645.82±878.44 d.At 1 mo,binocular UCDVA was lower than 0.20 logMAR in 76%of patients(mean 0.12±0.13 logMAR),which increased to 90%by 6 and 12 mo.The binocular UCDVA was significantly better than the monocular results(P<0.05)at 1,6,and 12 mo.Additionally,UCNVA was lower than 0.40 logMAR in 82%of patients,increasing to 90%by 6 and 12 mo.Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye(P<0.05)at 1,6,and 12 mo.About 5%of patients at 1 and 6 mo,reported"severe glare or halo".Patient satisfaction rates were 95%and 91%at 6 and 12 mo,respectively.CONCLUSION:Unilateral implantation of multifocal IOL in patients with a contralateral,monofocal IOL implantation results in high patient satisfaction rate,with low severe glare or halo rate during follow-up.It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.     

非球面人工晶状体在个体化人眼模型中成像质量的研究

目的 根据不同患者眼部解剖参数建立个体化眼模型,研究植入不同设计的人工晶状体（IOL）后的光学表现.方法 计算机数字模拟实验.采用Pentacam眼前节分析系统、IOL Master采集白内障摘除联合IOL植入术后人眼结构数据,应用ZEMAX光学设计软件建立个体化眼模型,分别模拟植入不同设计的3种非球面IOL（SofPort AO、Tecnis Z9000、FY60AD）和1种球面IOL（YA60BBR）,计算这些IOL眼3 mm、4 mm、5 mm瞳孔下的调制传递函数（MTF）和对比敏感度函数（CSF）曲线.结果 随瞳孔直径增加,全眼MTF、CSF曲线高度下降;3 mm瞳孔下,个体化眼模型中3种非球面IOL的MTF和CSF曲线与球面IOL接近;5 mm瞳孔下,个体化眼模型植入4种IOL后MTF和CSF曲线差异明显,不同解剖结构参数个体获得最佳MTF和CSF曲线的IOL种类不同,在空间频率较高时更加明显.结论 根据人眼解剖参数建立个体化眼模型可以模拟该个体眼睛光学系统的光学质量.不同解剖结构的人眼光学系统获得最佳视觉质量所需的IOL种类不同.     

Retinal image quality after microincision intraocular lens implantation

PURPOSE: To evaluate the modulation-transfer function (MTF) in eyes implanted with a conventional intraocular lens (IOL) and 2 IOLs designed for microincision cataract surgery (MICS). SETTING: Research, Development, and Innovation Department, Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective nonrandomized consecutive series comprised 30 eyes implanted with 1 of the following IOLs: conventional acrylic foldable (AcrySof MA60BM, Alcon Laboratories) or the UltraChoice 1.0 ThinOptX (ThinOptX Inc.) or the Acri.Smart 48S (Acri.Tech) MICS IOL. The 0.5 MTF and 0.1 MTF following MICS were calculated 3 months after implantation with the Optical Quality Analysis System (OQAS) for a 5 mm pupil. The differences were statistically analyzed with the Mann-Whitney U test. RESULTS: The values of 0.5 MTF for AcrySof, UltraChoice, ThinOptX, and Acri.Smart IOLs were, respectively, 2.647 cycles per degree (cpd) +/- 0.833 (SD), 2.601 +/- 0.986 cpd, and 3.453 +/- 0.778 cpd. The mean 0.1 MTF values for the same IOLs were 8.720 +/- 3.074 cpd, 8.814 +/- 4.380 cpd, and 11.418 +/- 2.574 cpd, respectively. Statistical analysis did not show significant differences in 0.5 MTF and 0.1 MTF between the conventional IOL and MICS IOLs. CONCLUSIONS: Microincision cataract surgery IOLs showed excellent MTF performance when implanted after cataract surgery, equal to that of conventional IOLs. An in vivo MTF study may be an excellent option to evaluate IOL performance in the eye.     

Primary repair and intraocular lens implantation after perforating eye injury

PURPOSE: To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma. METHODS: Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV(R)) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth(R), Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration. RESULTS: The final best spectacle-corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow-up. The mean follow-up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy. CONCLUSIONS: Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.     

非球面多焦点人工晶状体植入术后视觉质量的临床研究

目的比较2种多焦点人工晶状体IQReSTOR+3D和IQReSTOR+4D的临床效果。方法选择年龄相关性白内障患者32例(41眼)行白内障超声乳化吸除联合人工晶状体植入术,其中IQReSTOR+3D组15例(20眼),IQReSTOR+4D组17例(21眼),比较术后3个月2组患者的远距离、中距离和近距离视力、对比敏感度、视野、离焦曲线和生活问卷调查结果。结果术后3个月,IQReSTOR+3D组裸眼中距离视力为1.38±0.06,优于IQReSTOR+4D组(1.07±0.09),差异有统计学意义(P<0.05)。2组间近距离和远距离视力差异均无统计学意义(均为P>0.05)。离焦曲线IQReSTOR+3D组在-1.5D、-2.0D、-2.5D的视力均优于IQReSTOR+4D组,差异均有统计学意义(均为P<0.05)。结论 IQReSTOR+3D较IQReSTOR+4D能够提供更好的中距离视力和一定距离范围的近视力。     

Optical quality testing of monofocal intraocular lens implants with a 3 mm and a 4 mm aperture

The optical quality of 81 monofocal poly(methyl methacrylate) intraocular lenses (IOLs) from eight U.S. firms was tested using a 3 mm aperture, as recommended by the American National Standards Institute Z80.7 standard for IOLs, and a 4 mm aperture. The use of the larger aperture had no effect on the measurements of refractive power and astigmatism. When examined with the 3 mm aperture, the average resolving power of the IOLs was 81% of the diffraction limit; when examined with the 4 mm aperture, the average resolving power was 67% of the diffraction limit. Use of the larger aperture would ensure that a larger area of the IOL had been examined. Incorporating the larger aperture into the ANSI minimum resolution requirement would not appreciably affect the rejection rate for currently manufactured monofocal lenses.     

个性化植入非球面人工晶状体术后视觉质量的临床观察

目的 观察根据患者角膜球差植入不同球差的非球面人工晶状体术后患者的视觉质量.方法 选择年龄相关性白内障患者62例(62眼)行白内障超声乳化吸出联合人工晶状体植入术,随机分为试验组及对照组,其中试验组32例(32眼)术前根据角膜球差植入非球面人工晶状体,对照组30例(30眼)随机植入非球面人工晶状体.术后3个月进行两组患者的视力、角膜球差、对比敏感度检查和生活问卷调查.结果 术后3个月,患者裸眼视力为4.89±0.57,与术前的4.00±0.31相比,差异有统计学意义(P=0.00),其中试验组裸眼视力为4.91±0.02,对照组为4.89±0.37,差异无统计学意义(P=0.48);最佳矫正视力试验组和对照组分别为4.97±0.21和4.97±0.18,差异亦无统计学意义(P=0.91);两组总角膜球差术后为(0.271±0.222) μm,与术前的(0.262±0.213) μm相比差异无统计学意义(P=0.47);对比敏感度检查在暗光及暗眩光状态下1.5c·d-1、3.0c·d-1、6.0c·d-1、12.0 c·d-、18.0c·d-1 15个不同空间频率下试验组均显著高于对照组(均为P＜0.05),在明光及明眩光状态5个空间频率下对比敏感度两组间差异均无统计学意义(均为P＞0.05);术后不良视觉症状发生率试验组少于对照组,患者满意度好于对照组(均为P＜0.05).结论 根据角膜球差植入非球面人工晶状体,术后均能够获得较满意的视觉质量,为个性化植入非球面人工晶状体这一方法的可行性提供了临床依据.     

有晶状体眼后房型人工晶状体植入术后患者干眼情况

目的：研究有晶状体眼后房型人工晶状体(ICL)植入术后患者干眼相关的临床变化,评价其眼表疾病的严重程度。

方法：前瞻性研究。纳入2019-09/10拟行ICL植入手术矫正近视的患者50例50眼。分别于术前,术后1wk,1、3mo时进行眼表疾病指数(OSDI)问卷评分和角膜染色评分(Oxford法)、泪膜破裂时间(TBUT)、基础泪液分泌量(SⅠt)、下睑中央泪河高度检查。

结果：OSDI问卷评分在术后1wk,1mo时较术前明显增加(P<0.05),至术后3mo恢复至术前水平,角膜染色评分在术后3mo基本恢复至术前水平,术后3mo与术后1wk比较有差异(χ²=5.267,P=0.022)。角膜染色评分在各个时间点均和OSDI问卷评分呈显著的正相关(r_s>0,P<0.05)。TBUT在术后1wk及1mo较术前明显降低(P<0.05),术后3mo恢复至术前水平。SⅠt和下睑中央泪河高度在术后各个时间点与术前相比无差异(P>0.05)。

结论：ICL植入术后早期会影响患者眼表泪膜的稳定性,使患者出现不同程度的干眼相关症状,OSDI问卷评分可以评价其主观不适症状。但到术后3mo,患者眼表泪膜稳定性恢复至术前水平。角膜染色阳性评分越高的患者,干眼相关症状越明显。     

Phakic implantation of a black intraocular lens in a blind eye with leukocoria

A 54-year-old woman with leukocoria from a white cataract requested evaluation for the undesired cosmetic appearance of her blind right eye. The eye was hypotonous from chronic total retinal detachment, and the lens appeared loose and partially resorbed. A solid, black poly(methyl methacrylate) intraocular prosthesis was placed in the phakic posterior chamber and sutured into the ciliary sulcus, leaving the lens undisturbed. The patient achieved excellent cosmesis and a significant improvement in self-image.